MPM 6.

13B
Rev 1/2017-09-015
Page 1 of 4

SEAFARER’S APPLICATION FORM

Date: 19 FEBRUARY 2021

Position Applied : MOTORMAN/OILER Name : DAN ANGELO C.
DIAZ
Date of Birth : APRIL 11, 1993 Place of Birth : STA MARIA, DVO DS
Status : SINGLE Nationality : FILIPINO
Contact no : 0906-5116-328
Email Address : dandansoy0411@gmail.com
Height : 175 CM Weight : 86 KGS.
Safety Shoes Size : 10 Coverall size : LARGE
Shirt Size (Officer only) : N/A Pants Size (Officer only) : N/AS
: LAPU-LAPU ST. CADUNGOG SUBD. BRGY. POBLACION, STA MARIA, DAVAO
Address
OCCIDENTAL
Name of next Kin : MERCEDITA C. DIAZ Relationship : MOTHER
Address : LAPU-LAPU ST. CADUNGOG SUBD. BRGY. POBLACION, STA MARIA, DAVAO
OCCIDENTAL
Contact no : 0999-6833-308

Travel Documents
Subject Number Issued Date Expiry Date Issuing Authority
International Passport P4284094A 09/06/2017 09/05/2022 DFA
Nat’l Seaman Book C1092757 09/05/2017 09/03/2027 MARINA
National Seaman ID DA016810-13 11/14/2017
Flag SIRB -
Australian MCV
US Visa – Type D 20173289400020 11/28/2017 11/23/2022
Others visa

Educational Background
Name of School From To Type of certificate received upon
Graduation / Course
AGRO INDUSTRIAL FOUNDATION 2010 2013 BS MARINE ENGINEERING
COLLEGE OF THE PHILIPPINES

Certificate of Competence
Type STCW Flag Certificate Issued Date Expiry Date
Number
Nat’l COC in Rank III/1 PHILIPPINES 39-27541 10/03/2016 10/03/2021
COC Endorsement III/1 45-27475 10/03/2016 10/03/2021
National GMDSS
GMDSS Endorsement
Nat’l COC for Rating ASD / III/5 29-58281 10/03/2016
ASE
Flag License
Flag Tanker Product Oil
Flag Tanker Chemical

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MPM 6.13B
Rev 1/2017-09-015
Page 2 of 4

SEAFARER’S APPLICATION FORM

Flag SQ in Rank
Flag ECDIS
Flag BST
Flag SSO
Flag PSCRBC

Rank/Name:
Yellow Fever Date of expiry: LIFETIME
D&A tests on: TO FOLLOW
Chemical Blood Test on: TO FOLLOW
Pre-Medical on: TO FOLLOW Date of Expiry: TO FOLLOW

Other Courses / Certificates

Subject Country Number Issued Expiry
Basic Training (V1/1) PHILIPPINES 24-270107 10/03/2016 10/03/2021
-Personal Survival Techniques (VI/1-1)
-Fire Prevention & Fire Fighting (VI/1-2)
-Elementary First Aid (VI/1-3)
-Personal Safety & Social Responsibilities
(VI/1-4)
Basic Training in Oil and Chemical Tanker
Cargo Operations (V/1-1)
Proficiency Survival Craft and Rescue Boats
(VI/2) 15-396910 10/03/2016 10/03/2021
Advanced Fire Fighting (VI/3) 17-204952 10/03/2016 10/03/2021
Watchkeeping as Rating Deck II/4 or II/5 /
Engine III/4 or III/5 26-92887 10/03/2016
Medical First Aid (VI/4-1) 18-267067 09/01/2016
Medical Care (VI/4-2)
Advanced Training in Oil Tanker (ATOT)
Advanced Training in Chemical Tanker
(ATCT)
ECDIS - Generic
ECDIS - Type Specific:
Bridge Team Management (Renew 5yearly)
Engine Team Management (Renew 5yearly)
Ship Simulator and Bridge Teamwork
Bridge Resource Management
Engine Resource Management
Ship Security Officer
Ship Security Awareness Training 27-344433 03/02/2015
Designated Security Duties 27-344433 03/02/2015
Ship Safety Officer Course
Radar Observation and Plotting
ARPA
Risk Assessment
Incident Investigation

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MPM 6.13B
Rev 1/2017-09-015
Page 3 of 4

SEAFARER’S APPLICATION FORM

Cyber Security
Fuel Management
SEEMP
Working Effectively Across Cultures
Auditor/Lead Auditor Training
AMOS FOR WINDOWS
Welding Certificate KLMA-E-15-
03/13/2015
11950
Ship’s Cook Certificate – MLC2006 Reg3.2
Annex 1&2
Food Handling Certificate – MLC2006 Reg3.2
Annex 1&2 (For Cook and Msm only)
High Voltage Certificate
Carrying Dangerous and Hazardous Cargoes
Crude Oil Washing/Inert Gas System
Operations
Welding Certificate
Basic Lathe Machine Course
Free Fall Lifeboat Familiarization 15FFLB-F- 07/16/2015
0020-006
Framo Course
Shore-Based Fire Fighting
Ship Handling & Maneuvering - Management
Ship Handling & Maneuvering - Operation
Cargo Handling Simulator Training for Product
Tanker
Cargo Handling Simulator Training for Crude
Oil Tanker
Cargo Handling Simulator Training for
Chemical Tanker
ISM Awareness Course
Malaysia EDUCOR – For Officers only

Rank/Name: OILER DAN ANGELO C. DIAZ

Previous Sea Experience
Vessel Name Flag Employer Engine Type of Year GRT / Rank Period
Type & Vessel Built TEU From-To
KW
B&W 2013 02/25/2020
C/V TZINI VALLETTA BSM (14,280) CONTAINER 20,235 MOTORMAN -
12/09/2020
M/V MITSUBISHI 2001 03/06/19 -
CONTINENTAL PANAMA KLINE (13,940) PCC 55,493 OILER
11/21/19
HIGHWAY
B&W 2017 03/26/2018
M/V POLARIS
PANAMA KLINE (13,000) PCC 76,299 OILER -
HIGHWAY
10/19/2018
B&W 2OOO OILER 10/23/2016
M/V CORONA
KOBE KLINE (12,268) BULK 48,029 -
GARLAND
06/26/2017

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MPM 6.13B
Rev 1/2017-09-015
Page 4 of 4

SEAFARER’S APPLICATION FORM

B&W 2012 WIPER 08/26/2015
M/V CORONA
REIHOKU KLINE (9,966) BULK 46,896 -
QUEEN
06/10/2016

Rank/Name: OILER DAN ANGELO C. DIAZ

For New Candidate Only

Your Last Salary USD 1,400
Your Expected Salary USD 1,400

English Proficiency Very Good Good Average Below Average Poor

9 - 10 8 to 7 6-5 4 3-1
Oral X
Listening X

Interview by: To be filled by Admin

Processor: To be filled by Admin

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